The Problem of Access to Hepatitis B Treatment in the Balkan Country of North Macedonia

Abstract

Chronic hepatitis B (CHB) virus infection represents a global public health threat that causes considerable liver-related morbidity and mortality. In chronically infected patients, an elevated serum hepatitis B virus (HBV)-DNA concentration is the main risk factor for disease progression, although other clinical and viral characteristics can influence disease outcomes. At present, curing HBV infection is challenging in most patients and they need longterm antiviral treatment. The first-line treatments are nucleos(t) ide analogs (NAs) with a high barrier to resistance: tenofovir and entecavir, while in highly selected patients, an alternative treatment option is regulated interferon. Long-term therapy with NAs is safe and well tolerated, achieves potent viral suppression, and reduces the incidence of liver-related complications. For the majority of patients with CHB in North Macedonia, the current anti-HBV treatment is lamivudine with a low genetic barrier, which leads to compensatory mutations and resistance. With current vaccine strategy, applying therapies with effective high genetic barrier to resistance drugs, and improved linkage to care we should improve the treatment for patients with CHB and strive toward the World Health Organization goal of eliminating HBV as a global health threat by 2030.